NEW ELECTIVE COURSE OFFERING

NEW ELECTIVE COURSE OFFERING

APPLICATION FORM

(Academic Year 2010-2011)

Elective Type: Basic Science

A Basic Science Elective course is one in which the focus is on learning and applying advanced basic science principles and concepts. It can be presented in the laboratory or clinical environment and can extend beyond the “classic eight” (Anatomy, Biochemistry, Physiology, behavioral Sciences, Pharmacology, Microbiology, Immunology, and Pathology) to include Ethics, Humanities, Epidemiology, Nutrition, and Biostatistics. Whenever possible the basic sciences should be learned and evaluated in the context of solving patient problems. To that end, it is anticipated that clinical faculty will serve as consultants (and possibly co-faculty) in the development and/or delivery of the Basic Science Elective Courses. When there is a clinical component to the elective, students will be required to maintain an electronic logbook of patient encounters.

Name of Elective:

Department:

Faculty Responsible for Elective:

Telephone Number:

E-mail Address:

DESCRIPTION OF COURSE ACTIVITIES AND LOGISTICS: Please provide a concise but complete description of the course activities and experiences students will engage in during this elective course. Include performance expectations and any necessary logistical details.

STUDENT LEVEL: Is this course appropriate for Year Three students if prerequisites listed below are met?

	Yes, include this course in the Year Three Elective Catalog (maximum course length for Year Three students is 2 weeks).
	No, this course is appropriate ONLY for students who have successfully completed ALL Year Three Clerkships.

OBJECTIVES: Please list the specific and attainable learning objectives designed for this elective. Clearly describe the Basic Science objectives and the clinical integrative experiences that will be used to support those concepts, if applicable.

EVALUATION: Please describe the method(s) by which you will determine that the student has achieved the course objectives (observation, oral exam, written exam, case presentation, oral presentation, written essay, discussion with faculty, etc.).

ADDITIONAL FACULTY INVOLVED:

PREREQUISITES: (mark all of the following that apply)

Successful completion of all third-year clerkships.

Successful completion of the following clerkship(s):

Other (Please specify):

NOTIFICATION REQUIREMENT: How far in advance of the start date would you like the student to contact you?

	2 Weeks
	3 Weeks
	4 Weeks
	Other:
	N/A
	Contact Information (If other than responsible faculty) Name: Phone: Email:

ENROLLMENT: Indicate the minimum and maximum number of students you will take at one time in this elective.

MINIMUM: MAXIMUM:

Please indicate any additional enrollment restrictions that apply:

SCHEDULE: Please specify the LENGTH of the elective, and whether it is FULL-TIME or HALF-TIME. Half-time electives are offered mornings only or afternoons only. EXTENDED ELECTIVES are offered on Thursday afternoons only, in 5-week blocks (maximum of 6 blocks or 30 weeks). Unless specified to the contrary in the catalog description, all students taking electives in Springfield are released from regular elective activities on THURSDAY AFTERNOONS if they are enrolled in an Extended Elective Course. Mark all of the following that apply:

A.     SCHEDULE: (select one)

Full-time

Half-time

mornings

afternoons

Extended

B.     LENGTH

Regular

Extended

1 week

2 weeks

4 weeks

5 weeks

10 weeks

Credit Hours:      Minimum:    Maximum:

After pressing the "submit" button below, please print
the confirmation sheet and submit the completed
application form to your Elective Coordinator for
signature and further processing.

Nancy McCann-Stone (Curriculum Information)
Jean Afflerbach (Web Page)